帕金森病左旋多巴治疗患者的心血管疾病风险因素分析

发布时间：2018-04-21 20:28

本文选题：左旋多巴 + 同型半胱氨酸　；参考：《山东大学》2017年硕士论文

【摘要】：背景帕金森病(Parkinson's disease,PD)是一种中枢神经退行性疾病,以运动障碍为主要临床特点。由于PD的发病具有年龄依赖性,随着我国逐渐进入老龄化社会,PD患者的人数也将逐渐增加,已成为威胁老年人健康的重大临床问题。众所周知,左旋多巴是治疗PD患者的最常用药物,但有关研究显示长期服用左旋多巴会引起血浆同型半胱氨酸水平的升高。目前,同型半胱氨酸被认为是导致心血管疾病发病的危险因素,与心血管疾病发生密切相关。因此,我们推测长期服用左旋多巴治疗的PD患者可能处于罹患心脑血管疾病的危险之中。为此,本研究旨在探讨左旋多巴治疗组与非治疗组PD患者同型半胱氨酸水平的变化及其对心血管疾病的影响。研究目的检测左旋多巴治疗组与非治疗组PD患者血浆中同型半胱氨酸水平,通过超声心动图获取评价心血管功能的相关参数,验证左旋多巴长期治疗PD患者,是否会出现心血管功能的改变,这种改变与同型半胱氨酸的升高是否相关。研究方法收集于2014年1月至2016年12月在山东省立医院神经内科住院的PD患者96例,其中服用左旋多巴治疗超过1年的患者有53例,作为左旋多巴治疗组;未服用者有43例,作为左旋多巴非治疗组。其中排除合并有冠心病、高血压、糖尿病、先天性心脏病、心衰、慢性阻塞性肺病、房颤、起搏器植入、风湿性心瓣膜病、心脏瓣膜置换的患者。结果通过分析发现长期服用左旋多巴治疗的PD患者同型半胱氨酸的水平明显升高(15.38±5.43和11.79±3.65;P0.001);另外相比未进行治疗的PD患者,左旋多巴治疗后的患者二尖瓣舒张早期速度(E峰,cm/s)明显降低(82.64±13.87和66.43 ±9.86;P=0.002),E/A 的比值也明显下降(1.02±0.26和0.82± 0.19;P = 0.034),说明长期进行左旋多巴治疗的患者心脏早期舒张功能下降。另外,我们的数据也发现同型半胱氨酸的水平与E峰值及E/A的比值呈负相关性(r =-0.551,p0.01和r =-0.549,p0.01),说明左旋多巴可能通过同型半胱氨酸的升高引起心脏早期舒张功能下降。结论及意义本研究结果发现长期服用左旋多巴治疗的PD患者血浆同型半胱氨酸的水平明显升高,这与之前的研究是相一致的。并且超声心动图检测发现该组患者二尖瓣舒张早期速度及E/A的比值明显下降,说明患者的心脏早期舒张功能有一定程度的下降。另外,我们的数据也发现同型半胱氨酸的水平与E峰值及E/A的比值呈负相关性,说明左旋多巴可能通过同型半胱氨酸的升高引起心脏早期舒张功能下降。因此,长期服用左旋多巴治疗的患者可能有罹患心血管疾病的风险。
[Abstract]:Background Parkinsonian disease (PDD) is a degenerative disease of central nervous system, characterized by dyskinesia. As the incidence of PD is age-dependent, the number of PD patients will increase gradually with the aging society in China, which has become a major clinical problem threatening the health of the elderly. It is well known that levodopa is the most commonly used drug in the treatment of PD patients, but studies have shown that long-term administration of levodopa can increase plasma homocysteine levels. At present, homocysteine is considered to be a risk factor for cardiovascular disease and is closely related to cardiovascular disease. Therefore, we speculate that PD patients who take long-term levodopa may be at risk of cardiovascular and cerebrovascular disease. The aim of this study was to investigate the changes of homocysteine levels in PD patients and their effects on cardiovascular disease. Objective to detect plasma homocysteine levels in patients with PD treated with and without levodopa, and to obtain parameters for evaluating cardiovascular function by echocardiography to verify the long-term treatment of PD patients with levodopa. Whether changes in cardiovascular function occur and whether these changes are associated with an increase in homocysteine. Methods from January 2014 to December 2016, 96 PD patients were enrolled in the Department of Neurology, Shandong Provincial Hospital, including 53 patients who had been treated with levodopa for more than one year as the levodopa treatment group, and 43 patients who were not. As a levodopa treatment group. Patients with coronary heart disease, hypertension, diabetes, congenital heart disease, heart failure, chronic obstructive pulmonary disease, atrial fibrillation, pacemaker implantation, rheumatic heart valve disease, heart valve replacement are excluded. Results the levels of homocysteine in PD patients treated with levodopa for a long period of time were significantly increased by 15.38 卤5.43 and 11.79 卤3.65, P 0.001, respectively. The mitral early diastolic velocities of patients treated with levodopa were significantly decreased by 82.64 卤13.87 and 66.43 卤9.86P 0.002 / A, respectively, and the ratio of E / A was significantly decreased by 1.02 卤0.26 and 0.82 卤0.19 (P = 0.034), indicating that the early diastolic function of patients treated with L-dopa for a long time was decreased. In addition, we also found that homocysteine levels were negatively correlated with E peak and E / A ratios, suggesting that L-dopa may cause early cardiac diastolic decline through the elevation of homocysteine. Conclusion and significance this study found that plasma homocysteine levels were significantly increased in PD patients treated with long term levodopa, which was consistent with previous studies. The early diastolic velocity of mitral valve and the ratio of E / A were obviously decreased by echocardiography, which indicated that the early diastolic function of the patients was decreased to some extent. In addition, our data also found that homocysteine levels were negatively correlated with E peak and E / A ratio, suggesting that L-dopa may cause early diastolic dysfunction through the elevation of homocysteine. As a result, patients who take long-term levodopa may be at risk of cardiovascular disease.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5

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